Provider Demographics
NPI:1174519102
Name:FAIRVIEW HOME HEALTH LLC
Entity type:Organization
Organization Name:FAIRVIEW HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:802-371-8195
Mailing Address - Street 1:1025 W CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3318
Mailing Address - Country:US
Mailing Address - Phone:580-237-1819
Mailing Address - Fax:580-237-1822
Practice Address - Street 1:1025 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-3318
Practice Address - Country:US
Practice Address - Phone:580-237-1819
Practice Address - Fax:580-237-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7153251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHC7153OtherSTATE LICENSE